Chapter 11- Intrapartum and Postpartum Care of Caesarean Birth Families

Anesthesia Administration

-Bupivacaine is the preferred anesthetic agent for spinal and epidural blocks. -Preseravative free morphine or fentanyl is administered intrathecally to provide post op analgesia. -Epidural or spinal may be administered with the woman sitting on the OR table or lying on her side. If lying, position her with a hip tilt to maintain uterine displacement before, during, and after administration of anesthesia to decrease the risk of aortocaval compression related to compression on the aorta and inferior vena cava by the uterus.

Postoperative Cesarean Section Care

-The recovery time following a cesarean birth is longer compared to a vaginal delivery due to the tissue trauma related to surgical hospital intervention. -The usual hospital stay is 3 days, but full recovery can take 6 weeks or longer. -Maternal morbidity rate is increased twofold with cesarean delivery compared to vaginal. -Twofold increase us rehospitalization -Rates of complications based on status of cesarean and emergency versus planned. Rates of infection are higher with emergency c-sections, reported at 12%. Wound complications are 1.2% and operative injury is 0.5%.

Contraindications for Epidural or Spinal Anesthesia

1. Low platelet count is the most common contraindication, especially with women who have preeclampsia or HELLP syndrome. 2. Infection or dermatological issues of concern at the site of needle insertion. 3. Uncorrected maternal hypovolemia. 4. The woman's refusal or inability to cooperate with the procedure. 5. Spine abnormalities, injuries, or surgeries. 6. Sepsis.

Fetal Medical Indications for Cesarean Births

1. Malpresentation or malposition of the fetus such as breech, transverse lie, persistent occiput posterior position, fetal hand preceding the fetal head, or asynclitism (oblique malpresentation of the head) 2. Category II or III FHR pattern 3. Multiple gestation

Preparation for Discharge

1. Monitor incision for dehiscence and swelling 2. Assess fundus and lochia (bright red, brown, to yellow) 3. Manage pain, discontinue IV and foley, and monitor for VTE (painful, swollen leg) 4. Remove staples before discharge 5. Instruct family on the need for assistance 6. Facilitate bonding 7. Discharge teaching for mother and infant

24 Hours Postoperative to Discharge- Nursing Actions

1. Monitor vital signs per protocol, generally every 4 hours 2. Assess breath sounds, instruct the woman to deep breath and cough every 2 hours. Instruct incentive spirometer per order 3. Assess postoperative pain and medicate as indicated, use non pharmacological strategies as well 4. Assess the fundus and lochia, use gentle pressure when assessing because the abdomen will be tender 5. Monitor for signs of hemorrhage and infection 6. Assess the abdominal dressing or wound for drainage and signs of infection 7. Administer antibiotics as ordered 8. Remove the foley as ordered when the woman can ambulate to the bathroom. It generally occurs 8 to 12 hours postsurgery, ensure the woman voids at least 200 to 300 mL after removal and from the provider if she cannot (over distention can cause sub involution and hemorrhage) 9. Encourage oral fluid intake to assist in hydration and discontinue IV fluids as ordered, when the woman can take fluids by mouth without nausea 10. Assess bowel sounds and allow the woman to eat regular desired foods unless ordered otherwise. Patients who eat solid foods earlier have shown earlier return of bowel function

Maternal Medical Indications for Cesarean Births

1. Previous cesarean birth 2. Placental abnormalities 3. Mechanical impediment of the progress of labor or arrest of active labor 4. CPD, which occurs when ineffective uterine contractions lead to prolonged first stage of labor, when the size, shape, position of the fetal head prevents it from passing through the pelvis, or when the bony pelvis is not large enough or shaped for fetal descent 5. Previous uterine surgery (surgeries that involve an incision through the myometrium of the uterus) 6. Preexisting or pregnancy related maternal health factors like cardiac disease, severe hypertension (preeclampsia), severe diabetes, or obesity

First 24 Hours After Birth- Nursing Actions

1. Review prenatal, labor, and intrapartal records for risk factors. 2. Monitor vita signs per protocol, monitor every hour for the first 24 after administration of intrathecal morphine, and monitor for hemorrhage. 3. Assess the fundus and lochia per protocol. 4. Assess the abdominal dressing for signs of bleeding. 5. Ass the level of pain and use pharmacological and nonpharmalogical interventions 6. Monitor for side effects of intrathecal morphine and provide appropriate interventions. 7. Monitor the level of sensation and monitor for seizures, spinal headache, and neurological deficits. 8. Auscultate the lungs, encourage deep breathing and coughing, and incentive spirometry. 9. Monitor intake and output per foley catheter and the first 24 hours after removal. 10. Advance diet as tolerate. 11. Regulate IV fluids as ordered, oxytocin is added initially, to reduce the risk of hemorrhage related to uterine atony.

24 Hours Postoperative to Discharge- Normal Findings

1. Vital signs and glucose within normal limits, temperature elevations can be a sign of infection 2. Lung sounds clear bilaterally, the woman takes deep breaths and coughs every 2 hours while awake 3. Pain is a 3 or below 4. The fundus is firm and midline at one finger breadth below the umbilicus, lochia is moderate to scant 5. The abdominal incision is clean, intact, approximated, and free of redness, edema, warmth, and drainage 6. The woman spontaneously voids at least 200mL within 2 to 3 hours of foley removal, she can ambulate to the bathroom and in hallways 7. Bowel sounds are present and the women reports passing gas 8. The woman can tolerate oral fluids and food

First 24 Hours After Birth- Normal Findings

1. Vital signs are within normal limits 2. Lochia is moderte to scant 3. The fundus is firm and midline and generally 1 to 2 cm above the umbilicus initially, moving down throughout the hospital stay 4. The abdominal dressing is dry 5. The catheter is draining clear/yellow urine. A small amount of blood in the urine may be present when there has been trauma to the bladder during the procedure. 6. The IV site is free of inflammation or infiltration 7. Pain is below a 3 or within the woman's chosen number limits 8. Regains full motor and sensory function and sits at the bedside for short periods of time

Maternal Newborn Bonding- 24 Hours Postoperative to Discharge

24 hours after birth up to discharge, bonding should include: 1. Assist the woman into a comfortable position for infant feeding. Breastfeeding mothers may be more comfortable in a side-lying position or football hold, which prevents pressure on the abdomen. 2. Assist with infant care 3. Facilitate mother-infant attachment by bringing the infant to the woman and ensuring the woman's comfort 4. Instruct the family that they need to assist the woman with infant care and housework, she needs 6 weeks to recover from surgery 5. Provide opportunities for the family to ask questions and provide teaching on infant care, post op care, and post partum care 6. Remove staples before discharge per protocol, if not removed in the hospital, the woman will have to make an appointment 7. The woman should be able to feed her newborn with or without assistance, care for the needs of the newborn, and talk about the experience 8. The woman may remain in the taking-in phase longer, as her focus is on pain control and integration of the birthing experience

Scheduled Cesarean Birth

A cesarean birth classification, they occur before the onset of labor. Common reasons for a scheduled cesarean birth include: 1. Previous c-section 2. Maternal or fetal health conditions that place the woman or fetus at risk during labor and/or a vaginal birth 3. Malpresentation, such as breech presentation, diagnosed before labor 4. CDMR

Emergent Cesarean Birth

An unscheduled cesarean birth classification, it indicates an immediate need to deliver the fetus. The baby must get out as soon as possible. Indications include umbilical cord prolapse, abruptions, or uterine rupture

Perioperative Care for Cesarean Birth

Care may vary based on the urgency of the cesarean birth. If it is planed, the couple is admitted to the labor unit the day of the surgery. If it is unplanned, they may not be prepared. The woman and her family feel anxious and have fears that the woman or infants health is in danger, they may not understand, and they may ask questions but there may not always be time to explain the reasons. It includes medical management and anesthesia management

Indications for Cesarean Births

Cesarean births are performed for maternal and/or fetal reasons. Labor arrest (34%) and non reassuring fetal tracings (23%) are the leading reasons for primary cesarean births in the US. Other reasons can be maternal medical indications or fetal medical indications.

Intraoperative Cesarean Birth Complications

Complications are rare because of advances in obstetrical anesthesia and surgical techniques. Woman who are healthy during pregnancy are at a low risk for complications but complications can include: 1. Hemorrhage which increases morbidity and mortality rates and can result in shock, DIC, renal or hepatic failure, and possibly the need for an emergency hysterectomy. 2. Bladder, ureter, and bowel trauma. 3. Maternal respiratory depression from anesthesia. 4. Maternal hypotension related to anesthesia, which increases the risk for fetal academia. 5. Inadvertent injection of the anesthesia into the maternal bloodstream which can cause ringing in ears, metallic taste, and hypotension that can lead to unconsciousness and cardiac arrest.

Perioperative Care for Unplanned Cesarean Birth- Nursing Actions

During the perioperative period, the nurse is responsible for the same thing as a planned cesarean. It is just at a faster pace. Transition to an unscheduled birth should be done in a timely manner. Guidelines in all hospitals the provide OB care should be capable of responding to OB emergencies within 30 minutes, hence the 30 minute "decision to incision rule." Differences include: 1. Notifying the anesthesia, labor and delivery team, and neonatal personnel. If it is planned, they are already aware. 2. Initiate continuous FHR monitoring, since it is unplanned, a category II or III is expected. 3. Administer oxygen when indicated (signs of fetal intolerance of labor). 4. Assess the woman's vital signs. There can be an increase in BP due to anxiety and an increase in temperature and pulse due to infection or dehydration. 5. Witness surgical consent, if planned, it would have already been obtained. 6. Help ensure the woman and her support person RECEIVE INFORMATION. It is often such a rush that things do not get explained. Provide support, explain the reason, answer questions, and communication with the health team to decrease fear, anxiety, and distress! Also teach her what to expect during the surgery.

Perioperative Care for Planned Cesarean Birth- Nursing Actions

During the perioperative period, the nurse is responsible for: 1. Completing admission orders including baseline vital signs, laboratory screening (CBC, platelets, type, and screen) and required preoperative forms. A delay in lab results can delay the surgery. 2. Obtain a baseline FHR monitor strip of at least 20 minutes before and after administration of regional anesthesia if possible. 3. Review the prenatal chart for factors that place the woman at risk during or after cesarean birth and ensure the physician and anesthesia provider are aware of risk factors such as low platelet count. 4. Verify that the woman has been NPO for 6 to 8 hours before surgery. 5. Start an IV line and administer IV fluid preload as per orders, usually 500-1,000mL pre warmed before anesthesia to increase volume and decrease risk of hypotension. 6. Insert a foley catheter as per order, it is inserted preferably in the operating room after anesthesia and before the prep. 7. Clip hair prn before entering the OR, shaving is not advised because it can increase infection risk. 8. Administer preoperative medications per orders including antibiotics (cefazolin, clindamycin) 30-60 minutes before cut, VTE prophylaxis (preop anticoagulant if high risk or SCDs), sodium citrate for stomach acids, and famotidine to reduce nausea and vomiting. 9. Prepare the partner who plans to be present for the experience by providing surgical attire to wear, instruct them where to sit, and what to anticipate (sights, sounds, and smells). Provide emotional support as they wait to be transferred to the OR. 10. Complete the preop checklist, which includes removal of jewelry, eyeglasses, contacts, and dentures. Eyeglasses can be given to the support person so the woman can see her baby.

Intraoperative Care for Cesarean Birth- Nursing Actions

During the surgery, the nurses responsibilities include: 1. Position the patient. Position with a hip tilt to maintain uterine displacement before, during, and after administration of anesthesia to decrease compression of the aorta and inferior vena cava (aortaocaval compression) from the uterus. 2. Continue external FHR monitoring until abdominal prep is initiated. Remove the fetal scalp electrode after prep and before delivery, it should not be removed until the MD orders it. 3. Conduct a time out before anesthesia and before the initial incision to make sure it is the correct patient, site, and procedure. 4. Assist the woman into position for spinal/epidural and reposition after into a supine position with a left lateral tilt, secure the woman to the table with a strap over her upper legs. 5. Ground the patient, apply the device to the woman's leg which is a pad for cauterization. 6. Insert the foley. 7. Perform abdominal skin prep with sterile technique. 8. Perform the duties of a circulating nurse, including instrument count, needle count, and sponge count. Check equipment used for the newborn to ensure it works and all supplies are readily available. 9. Provide emotional support for the mother and family. 10. Provide care for the neonate, the 1 and 5 minute apgar should be above 7 unless there is intolerance. 11. Document. Record the time of delivery of the neonate and placenta, complete identification bands, etc.

Maternal Newborn Bonding- First 24 Hours After Birth

In the first 24 hours after birth, bonding should include: 1. Skin to skin contact with parents and infant. Position to avoid sudden unexpected newborn collapse (SUNC). It is when healthy infants experience sudden respiratory or cardiac arrest during the first few hours of life. To decrease risk, the mother should be in semi-fowlers or higher and the baby should not be prone. The newborn's face should be turned to the side. Newborn prone position on the mother's chest, especially if the mother is on her back can contribute to SUNC. 2. Assist the woman into a comfortable position for infant feeding, the woman should feed her newborn with or without assistance. 3. Assist with infant care and provide teaching as indicated 4. Provide emotional support by listening to the couple recall their birth experience and addressing their questions 5. The partner and family should assist in care of the newborn, they may need time to rest 6. Women with unplanned c-sections may feel guilt, failure, or disappointment. They may ask questions about the c-section and events leading up to it. 7. They will want time alone and will call family and friends, informing them of birth.

Clinical Pathways

Includes different focuses of care for different parts of the cesarean experience- preoperative, intraoperative, immediate postoperative, first 24 hours post op, and up to discharge. There are different expectations for each focus at each different stage. Focuses of care include: 1. Assessments 2. Activities 3. Education 4. Elimination 5. Emotional needs 6. Medication 7. Nutrition 8. Pain management

Perioperative Care for Unplanned Cesarean Birth- Anesthesia Management

Includes: 1. Anesthesia provider completes an anesthesia history and physical, and discusses options with the woman, this may not occur until the OR depending on the amount of time. 2. The anesthesia provider determines the need for a platelet count. 3. The anesthesia provider explains the procedure and addresses the woman's and support persons's questions and concerns.

Perioperative Care for Planned Cesarean Birth- Medical Management

Includes: 1. Consent, the surgeon will explain the reason for c-section and what it involves prior to admission and obtain surgical consent. 2. The surgery is scheduled. 3. Presurgical diagnostic laboratory tests such as a CBC, blood type, and Rh, are ordered. 4. Education is provided about which current mediations she should take or eliminate on the day of surgery 5. To prevent postoperative infection, many providers recommend that the woman take at least one pre-op shower at home using an antiseptic agent (chlorhexadine) the night before

Perioperative Care for Planned Cesarean Birth- Anesthesia Management

Includes: 1. The anesthesia provider (anesthesiologist or CRNA) meets with the couple during the admission process and before the woman is transferred to the operating room. 2. The anesthesia provider reviews the prenatal record. 3. The anesthesia provider completes an anesthesia history and physical, discuses options with the couple, and answers their questions regarding anesthesia

Perioperative Care for Unplanned Cesarean Birth- Medical Management

Includes: 1. Determine the need for a cesarean birth. 2. Explain the reason for the cesarean birth. 3. Explain the procedure and obtain consent.

Intraoperative Medications

Intraoperative medications that can be given with anesthesia management include: 1. Antibiotics, generally within 1 hour of the incision time. 2. Oxytocin, after delivery of the placenta to minimize bleeding.

Risks of Cesarean Births

Maternal deaths related to c-sections have decreased in the US due to improved surgical techniques, anesthetic care, and the availability of blood transfusion and antibiotic therapy, but this procedure still poses a risk to the woman and her fetus. Risks include: 1. Maternal morbidity and mortality including postpartum infection, hemorrhage, thromboembolic disease, and maternal death. 2. Fetal morbidity and mortality including fetal injury during surgery, low Apgar scores, and respiratory distress. 3. Placentation issues related to repeat cesarean births

First 24 Hours After Birth- Medical Management

Medical management for the first 24 hours after birth include: 1. Assess for involutional changes and signs of potential complications 2. Assess pulmonary function, look for atelectasis and pneumonia 3. Assess for ilues, cholecystitis, persistent nausea and vomiting, and intestinal obstruction 4. Medical orders are usually standardized and include IV therapy, medications such as analgesia and stool softeners, antibiotic therapy for women at risk for infection (prolonged rupture of membranes, prolonged labor, or elevated temperature), progression of diet, removal of the foley (12 hours post surgery), and activity level 5. Immediate care of the newborn is the same for vaginal delivery

Monitoring the Maternal Response

Once anesthesia is administered, it is important to monitor the maternal response which includes: 1. Vital signs and oxygenation. They should be within normal limits with a potential mild increase in blood pressure due to anxiety or a decrease following administration. 2. Level of anesthesia, effectiveness, and complications. Complications of general anesthesia include gastric aspiration, aspiration of gastric contents can lead to pneumonitis. Additional risks for aspiration include morbid obesity, diabetes, and a difficult airway. 3. Blood loss. This is accomplished when the circulating nurse weights lap sponges for a quantified blood loss (QBL) and reports findings to the surgical team. Up to 1,000mL is expected.

Preventing Cesarean Births

One in three infants born in the US are delivered by cesarean birth. Unnecessary c-sections are a public health concern and the 31.9% rate exposes women and infants to unnecessary risks in the perinatal period and long term, and results in unnecessary health care costs. To prevent c-sections, include: 1. Induce for medical and not for elective reasons, this is key to reduce cesarean delivery rates. If non-medical induction is done, the age should be at least 39 weeks or more and the cervix should be favorable, especially in the nulliparous woman. 2. Cervical ripening agents (things to soften the cervix) for inductions in women with an unfavorable cervix. 3. Allow second stage to proceed without precipitous intervention 4. Consider vacuum or forceps assisted birth (operative vaginal delivery) when indicated, can safely prevent cesarean deliveries in appropriate situations. 5. Trial of labor for multiples (twins) when the first twin is in a vertex position. 6. Version, external cephalic version can be done to manually turn and correct and breech presentation before labor. 7. Standardize FHR interpretations and management. 8. Implement non-medical labor support interventions such as continuous labor support from a nurse or a doula. 9. When inducing labor, allow longer duration of the latent phase for up to 24 hours and administer oxytocin for at least 12 to 18 hours after membrane rupture before performing c-section for failed induction.

C-Section Nursing Outcomes

Related to a health birth, family adjustment, and recovery: 1. Parents will verbalize understanding of factors that contributed to the need for caesarean birth 2. The woman will experience an uncomplicated intraoperative period and postoperative recovery 3. The woman will have adequate urinary output and normal amounts of lochia 4. The woman will verbalize a pain level she finds acceptable on a scale of 0 to 10 5. The woman will be afebrile and the abdominal incision site will be free of infection 6. The parents will hold the infant close to the body and demonstrate appropriate attachment behavior and care for infant needs

C-Section Nursing Diagnosis

Related to maternal and infant risks: 1. At risk for low self esteem related to perceived failure of life event 2. At risk for injury related to surgical procedure and effects of anesthesia 3. At risk for fluid volume deficit related to blood loss and oral fluid restriction 4. At risk for acute pain related to surgical incision 5. At risk for infection related to surgical incision, tissue trauma, or prolonged rupture of membranes 6. At risk for altered parent-infant attachment related to surgical intervention

Intraoperative Team

The complete team for a cesarean section includes a surgeon, an anesthesia provider, a surgical first assist, a circulating nurse, and neonatal staff. The circulating nurse is responsible for patient safety. This includes positioning the patient, ensuring time-outs and consents are complete, confirming the presence of newborn providers, maintaining the correct count of supplies, labeling specimens correctly, and confirming their disposition to pathology or medical waste.

24 Hours Postoperative to Discharge- Medical Management

The following medical management take place before the mother and baby are discharged: 1. Assess for involutional changes and signs of postoperative complications 2. Administer antibiotics for women who experience a prolonged labor, prolonged rupture of membranes, or who are afebrile 3. Remove abdominal dressing and assess for signs of dehiscence and infection. It is usually removed on the first postoperative day 4. Provide discharge instructions

Pfannenstiel Incision

The most common incision for cesarean sections, it is also known as the "bikini cut." It is a transverse skin incision made at the level of the pubic hairline. Typically, a lower uterine segment incision is performed on the uterus.

Placentation Issues Related to Repeat Cesarean Birth

The most significant long-term complication of repeat surgical birth is placenta accreta. The previous c-section causes a scar in the uterus which may cause the placenta to attach wrong. In all forms, the placenta does not separate from the uterine wall after delivery, potentially leading to hemorrhage, DIC, organ failure, and death. Typically, a hysterectomy is needed to control a massive hemorrhage. The spectrum of placenta accreta includes: 1. Accreta- the placenta grows into the uterine muscle but does not penetrate the entire thickness of the uterine muscle 2. Increta- the placenta grows into the uterine muscle and extends farther into the myometrium 3. Percreta- the placenta grows through the full uterine muscle and may attach to other internal organs, such as the intestine or bladder

Cesarean Birth Differences

The needs and experiences of cesarean birth couples are different than those who had a vaginal birth. Differences include: -Increased length of hospitalization -Longer period of physical recovery -Increased pain -Increased negative emotional responses to childbirth experience -Unplanned cesareans may cause feelings of guilt and failure for not achieving a vaginal birth, these feelings have decreased because c-sections are becoming more common

Increasing C-Section Rate

The rates of c-sections are increasing due to: 1. Decrease in VBAC and operative vaginal deliveries (forceps and vacuums) 2. Increase in the number of fetuses in breech position 3. Increase in the number of cesarean deliveries on maternal request (CDMR), it is a c-section performed at the request of the woman before labor and in the absence of maternal or fetal medical conditions that present a risk for labor 4. Increase in labor inductions, especially for nulliparous women or women with an unfavorable cervix 5. Increase in the average maternal age at delivery, women 35 and older are referred to as having a "geriatric pregnancy," or a "pregnancy with advanced maternal age." This population, especially those with their first pregnancy at this age, is at risk for c-section. Nearly half of c-sections occur in women over 40 6. Increase in malpractice litigation, providers would rather do a c-section than a risky delivery to avoid malpractice, although c-sections are more risky

Classical Incision

The second type of incision for cesarean sections, it is rare and is used in emergency births when immediate delivery is critical. It is a vertical abdominal wall incision and vertical incision in the body of the uterus.

Postoperative Care- Recovery in Surgical Suite

The woman and her newborn are transferred from the the operating room to the labor and delivery PACU. The purpose of PACU is to stabilize vital signs, bleeding, pain, itching, and nausea, and to monitor anesthesia level. One RN should be assigned to care for the mother and another to care for the newborn until critical elements like report, assessments, and stable vital signs are completed. Monitor: 1. Blood loss and uterine tone closely. Weight on scale pads and chug for accurate measurement of QBL (1 gram = 1mL). 2. Monitor input and output 3. Active warming measures to prevent hypothermia

Types of Anesthesia

To determine the type, include which is safest, most comfortable, has the least effect on the fetus, and which provides optimal conditions for surgery. Types include: 1. Spinal- preferred method for scheduled c-sections or for laboring women who do not have an epidural. It is faster than an epidural to place and provides a full sensory and motor block. 2. Epidural- used in laboring women who have an epidural in place for labor pain management and who then require a c-section. They may feel tugging and pulling during the procedure because epidurals are not as dense and do not provide a full sensory and motor block. 3. General- rarely used and carries increased risk. It is indicated for imperative rapid delivery, severe hemorrhage, seizures, or a failed spinal.

Intraoperative Care for Cesarean Birth- Medical Management

Two primary operative techniques are used for cesarean sections, the pfannenstiel incision, or a classical incision. The neonate is delivered through the uterine and abdominal inactions. After delivery of the neonate, the placenta is manually removed. The uterus may be lifted out of the abdominal cavity or left in place when the uterine incision is repaired. The abdominal tissues and incision are then repaired.

First 24 Hours After Birth- Anesthesia Management

When intrathecal morphine is used for postoperative pain management, the anesthesia provider manages the woman's pain for the first 24 hours and administers medications to counteract the side effects of intrathecal opioids. It is administered at 5 to 10mg for severe pain and works by altering perception of and response to painful stimuli and produces generalized CNS depression. Common side effects include: 1. Respiratory depression- administer oxygen as needed and naloxone as ordered 2. Pruritus- administer medication as ordered such as naloxone or diphenhydramine 3. Nausea/vomiting- administer naloxone or metoclopramide 4. Urinary retention- occurs after removal of foley, administer naloxone or catheterize as ordered

Postoperative Care Complications

Women who enter pregnancy in a healthy state and have experienced a healthy pregnancy are at a low risk for complications. In contrast, women who experience a prolonged labor, multiple interventions such as internal monitoring, or prolonged rupture of membranes are at a higher risk for post operative complications. Complications include: 1. Hemorrhage which can cause hypovolemic shock, DIC, renal or hepatic failure, and the possible need for a hysterectomy. 2. Anemia related to blood loss 3. DVT, promote movement 4. Pulmonary embolism, symptoms include dyspnea, tachypnea, chest tightness, SOB, hypotension, and decreasing O2 stat 5. Paralytic ileus, promote movement 6. Hematuria related to bladder trauma 7. Infections of the bladder, endometrium, and incision (serous or purulent drainage, erythema, fever, pain, and wound dehiscence) 8. Severe headache related to method of anesthesia (spinal headache) 9. Endometritis, signs include fever, chills, uterine tenderness, and foul-smelling lochia

Intraoperative Care for Cesarean Birth- Anesthesia Management

Includes: 1. Type of anesthesia 2. Monitoring the maternal response 3. Estimated blood loss 4. Administering intraoperative medications

Classifications of Cesarean Births

Cesarean births are classified as either scheduled (planned) or unscheduled (unplanned). Unscheduled cesarean births include emergent, urgent, and non urgent.

Nonurgent Cesarean Birth

An unscheduled cesarean birth classification, it indicates the need for a cesarean birth related to complications such as failure to progress (cervix does not fully dilate) and failure to descent (fetus does not descend through the pelvis) with a category I FHR.

Urgent Cesarean Birth

An unscheduled cesarean birth classification, it indicates the need for rapid delivery of the fetus. It needs to be done sooner than later, but it is not yet life or death. Indications include malpresentation diagnosed after labor onset or placenta previa with mild bleeding and fetal heart rate with a category I